Health Inequalities Among African Australians in Greater Melbourne: A Qualitative Intersectional Analysis of People’s Experiences and Immigrant Organisations’ Responses

Global migration poses unique challenges for migrant health and wellbeing. Within Australia, African Australians are a new and emerging population, and research concerning the health and wellbeing of the diverse people grouped under this socio-analytic category is limited. The extant literature emerging from the field of public health reveals several barriers to health and wellbeing for African Australians. Explanations for poor health outcomes among some African Australians tend to rely upon individual behavioural approaches that focus on individual attributes, behaviours, culture, and single-axis social determinants, with little attention paid to intersecting multiple dimensions of inequality. Without accounting for the interrelated nature of African Australians’ social locations and intersecting systems of oppression/privilege, practice and policy responses may have limited impact on redressing health inequalities. This research comprises two phases, where Phase 1 aimed to drive the focus of Phase 2 to an area of expressed importance to participants. Phase 1 of the research asked: From the perspectives of African Australians and non-African Australians working with and for African Australians, what are the priority concerns regarding African Australian health and wellbeing in Greater Melbourne? Phase 2 of the research, driven by the findings of Phase 1, sought to understand how members of African Australian immigrant organisations perceive their influence over, and work to improve, health and wellbeing. Phase 1 was a qualitative study that utilised intersectionality to analyse interview notes from two group interviews and 22 ‘slow interviews.’ An Issues Paper produced by 50 African Australians, was also reviewed as a secondary data source because it captured additional voices, therefore, widening the scope of the study. Interview participants included 35 African Australians and nine people of non-African backgrounds working with, and for, African Australians in the community sector. Phase 1 findings reveal that systems of oppression/privilege negatively influence health and wellbeing for specific African Australians at the intersections of race/ethnicity, migration pathway, age, and gender. Health outcomes are found to be influenced by segregation and Othering in education, labour market discrimination, and gendered racism in health-care provision. Furthermore, racism, ageism, and sexism are found to challenge the identity construction of young African Australian women, increasing their risk of homelessness. Interpersonal and structural racism at the intersections of migration pathway, gender, and age also produce particular vulnerabilities for poor mental health. Phase 1 findings also highlight the existence of, and structural barriers facing, African Australian immigrant organisations in an under-resourced and competitive community welfare sector. Participants expressed a strong desire for African Australians to drive and implement solutions to these health concerns, and immigrant organisations presented as a setting for this to occur. These findings shaped the focus of Phase 2. Despite the common tendency across different countries for immigrants to form organisations, there is a dearth of literature about immigrant organisations broadly, with little known of their efforts to reduce health inequalities. Therefore, driven by the concerns raised in Phase 1, Phase 2 of the research bridges literature from third sector studies, migration studies, and public health, with an empirical dual-case study and intersectional analysis of two African Australian immigrant organisations operating in Greater Melbourne. The study explores the potential of these immigrant organisations as health settings to reduce health inequalities identified in Phase 1. Data collected from observation, in-depth interviews, reflexive interviews, and document review were analysed through the lens of intersectionality. Phase 2 findings identify key mechanisms for influencing African Australian health and wellbeing, including the acquisition of resources, growing networks, professional and personal development, generating solidarity, community capacity building, and advocacy. The activities of the participating African Australian immigrant organisations are found to contribute to a culture of health, empowering communities, and health advocacy. Findings also reveal that while the organisations resisted hierarchical forms of oppression/privilege through some of their activities, working within and through systems of oppression/privilege both constrained, and created opportunities for, their work. In some ways, systems of oppression/privilege were also reinforced and reproduced. This thesis extends current literature concerning immigrant organisations by highlighting their potential as valuable health settings, where activities for resisting, reinforcing, and reproducing systems of oppression/privilege can influence health and wellbeing